columnist Eamonn Fitzgerald

comments on the recent rise in ACL injuries

Just three letters to describe the injury that effectively kills a player’s season. When it comes to someone late in the sporting career, it may well hasten the premature ending of that player’s active sporting life. This week we return to the topic of sports injuries.

Anterior Cruciate Ligament, better known as ACL, is that dreaded injury sustained by sportspeople, and it’s on the increase. Spectators will surely have seen a player go down injured and if the knee is clutched what is foremost in the mind of the player is the fear that the cruciate is torn.

Why does it seem so frequent in modern sport? What are the prospects of the unfortunate player returning to play this season, or ever? What preventative strategies can be adopted to prevent this particular injury?

I have been in contact with specialist medics on ACL and I accept their expertise, to which I add personal opinions based on anecdotal evidence garnered from playing and also following a wide variety of sports that have informed this weekly column for half a century. Did you ever hear of the ACL in any sport, say, 50 years ago? More than likely one heard of a twisted knee, swelling out like a balloon. Then the player was told it was fluid in the knee; it can be drained. The swelling will go down after a short term on crutches and you’ll be good to go for the next round of the championship. If it didn’t pan out like that your sporting career was over at the age of 25.

The anterior cruciate ligament is a 3.5cm piece of a ligament in the centre of the knee which attaches the upper leg bone (femur) to the large lower leg bone (tibia) and acts as a hinge. Its main job is to prevent the shin bone from moving forward. This connective tissue is located in the middle of the knee and it provides stability to the knee so that when you twist and turn it stops the knee from giving way.

An anterior cruciate ligament injury occurs from the over-stretching or tearing of the ACL in the knee. A tear may be partial, moderate or complete.

In modern sport played at high intensity, players are moving faster and are well tuned in upper body strength and conditioning. In rugby games of the past, the usual try scorers most often were the wing three quarters. Light enough with electrifying pace well suited to be a sprinter in athletics. Take

Garry Ringrose as an example. He has terrific pace, but he is two inches over the 6 feet and weighs 96kgs (15st 1lb). Imagine the opposing full back trying to bring him to ground as he charges for the line and the expected try.

Brian Devitt is well placed to offer opinions on ACL. A Belvo boy who excelled in rugby during his school days, he continued to play the game for many years later - what else but rugger at Belvo?

He followed the medical journey, is highly qualified academically and is also a consultant orthopaedic surgeon well known to too many ACL tear sufferers.

Too often you hear that such and such a player had to attend a specialist for a scan on the injured knee. Usually, that meant surgery and the year-long rehab programme.

"In GAA, hurling and rugby, the ball is often played overhead, above a player's eye-line,” Prof. Devitt said. He can also add in other sports that are higher on ACL injuries such as basketball and soccer. Players in these codes have to do a lot of pivoting and turning sharply, putting huge strain of the knees, often leading to tears in the knee ligaments. Picture a player reaching for a high ball, landing, and trying to avoid an opponent by pivoting. There is a lot going on which requires huge co-ordination. Unfortunately, when this co-ordination fails, even for a split second, it can put the knee at risk of giving way to ACL injuries.

I feel that there are also several contributing factors leading to increasing ACL injuries. Games are played at a much faster pace than heretofore and with greater intensity. What level of shock absorption was in the basketball boots in the past decades? To increase the danger, playing surfaces for basketball were often too hard on the knee joints. Soccer depends a lot on leg power, swerving pivoting, trying to outwit an opponent.

I haven’t come across any decent scientific research on the part the footwear plays in injuries. Most modern boots are manufactured as light as possible, built for speed at the expense of protection. In so many brands the design presents as glorified slippers, especially for juveniles. Fashion dictates. Feet suffer.

Pitches also should be considered in this research. Many of the playing pitches of the present day are sand-